NEW YORK (Reuters Health) -
Wealthier high school students may be more likely to try
smoking hookah, according to a new study.

The water-pipe device with its series of tubes and mouthpieces looks
nothing like a cigarette, but is often used to smoke tobacco, and as
such carries many of the dangers inherent in cigarette smoking (see
Reuters Health story of February 21, 2014).

Researchers at New York University Langone Medical Center analyzed
data from questionnaires given to several thousand high school
seniors every year from 130 public and private schools in 48 states.

The survey first added questions about hookah use in 2010. The
current results include responses from about 5,500 students in 2010,
2011 and 2012 combined.

About 18% of students reported having tried hookah in the past year,
according to results published July 7 online in Pediatrics.

White and Hispanic students were considerably more likely to have
tried hookah than their black classmates, as had been found in other
studies. Students who lived in urban areas and had parents with
higher education levels were also more likely to have tried hookah.

Finally, hookah use was more common among kids with higher weekly
incomes and those who smoked cigarettes, drank alcohol or used other
illicit substances.

“We have found similar findings for cocaine - students with more
money are more likely to use,” said lead author Joseph J. Palamar.

“My second answer is that cigarette smoking has become a stigmatized
behavior over the last decade and it now tends to be associated with
lower socioeconomic status,” Palamar told Reuters Health in an
email. “Hookah, however, doesn’t appear to have the same ‘lower
class’ stigma that is now being applied to many cigarette smokers.”

It is also possible that hookah bars and their advertising, which
are often located near college campuses, are aimed at more affluent
and educated youth, noted coauthor Dr. Michael Weitzman.

Cigarette use is on the decline among U.S. youth but the decline is
offset by a rise in alternative forms of tobacco, including hookah,
according to a report from the Centers for Disease Control and
Prevention cited in the new study.

In many state legislatures, the definition of smoking does not
explicitly include hookah, which leads to some hookah bars being
exempt from smoke-free laws and minors allowed in hookah
establishments and near smoking paraphernalia.

“Recent work by our group indicates high levels of multiple
hazardous chemicals and particulate matter in the indoor air of NYC
hookah bars,” Weitzman said.

“Evidence suggests that hookah use may actually be more addictive
and more harmful than cigarettes,” he told Reuters Health in an
email. “A single water pipe session can equate to smoking 20 or more
cigarettes and yield greater levels of nicotine, tar and (carbon
monoxide) than cigarettes.”

Other studies have linked hookah smoking to decreased lung function
and lung cancer and to lower birth weights among the babies of
pregnant smokers, he said.

“Kids understand that cigarettes are really a bad thing for you and
contain lots of properties that are dangerous to you,” said tobacco
researcher Charlie Saunders of Florida State University College of
Medicine in Tallahassee. “They switch to tobacco alternatives many
times because they think they are less harmful and they also have
large concentrations of nicotine.”

But the flavorings in “shisha” make it easier to inhale, so hookah
can actually be more effective at getting nicotine into the body,
Saunders, who was not part of the new study, told Reuters Health.

“No, smoking hookah a couple times or once in a while isn’t as
dangerous as smoking cigarettes every day,” Palamar said. “But it is
a habit we need to get our teens to avoid.”